Provider First Line Business Practice Location Address:
210 EAST MAIN STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MIDDLETOWN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10940-4038
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
845-343-4848
Provider Business Practice Location Address Fax Number:
845-344-4482
Provider Enumeration Date:
09/01/2005